Volume 1, Issue 4 (Journal of Research in Dental & Maxillofacial Sciences Autumn 2016)                   J Res Dent Maxillofac Sci 2016, 1(4): 45-51 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Basirat M, pakfetrat A, Kakaei N, Rohani B, bashardoust N. Crohn’s Disease with Oral Onset - A Case Report. J Res Dent Maxillofac Sci. 2016; 1 (4) :45-51
URL: http://jrdms.dentaliau.ac.ir/article-1-131-en.html
1- Assistant Professor, Department of Oral medicine, Faculty of Dentistry, Guilan University of Medical Sciences, Rasht, Iran.
2- Professor, Department of oral Medicine , Oral and Maxillofacial Disease Research Center, Mashhad University of Medical Sciences, Iran
3- Dentistry student of Guilan university of medical science – International Branch, Dental School, Guilan, Islamic Republic of Iran
4- Assistant Professor, Department of Oral medicine , Faculty of Dentistry, AJA University of Medical Sciences, Tehran, Iran
5- Assistant Professor, Oral and Maxillofacial pathology Dept, Dentistry faculty, Guilan University of Medical Sciences, Rasht, Iran , bashardoust.dental@gmail.com
Abstract:   (3701 Views)

Background: Crohn’s disease is an inflammatory bowel disease that can affect any part of the gastrointestinal (GI) tract including the mouth. Bowel symptoms are predominant. Oral involvement may precede the GI symptoms. This case report presents a patient affected by Crohn’s disease with oral onset.
Case presentation: We present a 30-year-old pregnant woman complaining of chronic, multiple, yellow-white crusted ulcers predominantly involving the lips. In addition, there were small painless lesions on the palate, buccal and labial attached gingivae, alveolar mucosa and vestibule. The lesions were present since 3 months ago. The patient had not previously experienced any oral lesions or systemic diseases. The laboratory tests were normal.  Laboratory investigation showed increase in neutrophil and eosinophil count. Incisional biopsy of the buccal mucosal lesions was performed. In histopathological examination, acanthotic and parakeratotic epithelium with intraepithelial clefts was observed. Inflammatory cells such as eosinophil and polymorphonuclear (PMN) leukocytes were profoundly present in the clefts and diffusely in the epithelium. Blood vessels, collagen fibers and in-depth muscle and fat tissues were also observed. Based on these characteristics, the diagnosis of pyostomatitis vegetans was made. Considering the biopsy results and the presence of GI symptoms such as abdominal pain and diarrhea after postpartum, Crohn’s disease was suspected and therefore, the patient was referred to a gastroenterologist for definitive diagnosis and treatment. The patient showed the diagnostic signs of Crohn’s disease.
Conclusion: This report emphasizes the important role of oral lesions as the first sign in the diagnosis of systemic diseases.

Full-Text [PDF 207 kb]   (1583 Downloads) |   |   Full-Text (HTML)  (471 Views)  
Type of Study: Case report | Subject: Oral medicine

1. Vahedi H, Merat S, Momtahen S, Olfati G, Kazzazi A-S, Tabrizian T, et al. Epidemiologic characteristics of 500 patients with inflammatory bowel disease in Iran studied from 2004 through 2007. Arch Iran Med 2009;12(5):454-60.
2. Malekzadeh F, Alberti C, Nouraei M, Vahedi H, Zaccaria I, Meinzer U, et al. Crohn’s disease and early exposure to domestic refrigeration. PLoS One 2009;4(1):e4288.
3. Galbraith SS, Drolet BA, Kugathasan S, Paller AS, Esterly NB. Asymptomatic inflammatory bowel disease presenting with mucocutaneous findings. Pediatrics 2005;116(3):e439-e44.
4. Lourenço SV, Hussein TP, Bologna SB, Sipahi AM, Nico MM. Oral manifestations of inflammatory bowel disease: a review based on the observation of six cases. J Eur Acad Dermatol Venereol 2010;24(2):204-7.
5. Ruiz Serrato A, Marín García D, Guerrero León MA, Vallejo Herrera MJ, Villar Jiménez J, Cárdenas Lafuente F, et al. Palpebral ptosis, a rare ocular manifestation of Crohn's disease. Arch Soc Esp Oftalmol 2013;88(8):323-6.
6. Katz J, Shenkman A, Stavropoulos F, Melzer E. Oral signs and symptoms in relation to disease activity and site of involvement in patients with inflammatory bowel disease. Oral Dis 2003;9(1):34-40.
7. Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM. Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 2011;17(1):423-39.
8. Baumgart DC, Sandborn WJ. Crohn's disease. Lancet 2012;380(9853):1590-605.
9. Chi AC, Neville BW, Krayer JW, Gonsalves WC. Oral manifestations of systemic disease. Am Fam Physician 2010;82(11):1381-8.
10. 1
11. Merigo E, Fornaini C, Manfredi M, Meleti M, Alberici F, Corcione L, et al. Orofacial granulomatosis treated with low-level laser therapy: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113(6):e25-9.
12. Mays JW,Sarmadi M,Moutsopoulos NM. Oral manifestations of systemic autoimmune and inflammatory diseases: diagnosis and clinical management. J Evid Based Dent Pract 2012;12(3 Suppl):265-82.
13. Longui CA.Glucocorticoid therapy:minimizing side effects. J Pediatr (Rio J) 2007;83(5 Suppl):S163-77.
14. William T, Marsch WC, Schmidt F, Kreft B. Early oral presentation of Crohn's disease. J Dtsch Dermatol Ges 2007;5(8):678-9.
15. Dupuy A, Cosnes J, Revuz J, Delchier JC, Gendre JP, Cosnes A. Oral Crohn disease: clinical characteristics and long-term follow-up of 9 cases. Arch Dermatol 1999;135(4):439-42.
16. Mignogna MD, Fortuna G, Leuci S, Amato M. Oral Crohn's disease: a favorable clinical response with delayed-release triamcinolone acetonide intralesional injections. Am J Gastroenterol 2008;103(11):2954-5.
17. Zbar AP, Ben-Horin S, Beer-Gabel M, Eliakim R. Oral Crohn's disease: Is it a separable disease from orofacial granulomatosis? A review. J Crohns Colitis 2012;6(2):135-42.
18. Stavropoulos F, Katz J, Guelmann M, Bimstein E. Oral ulcerations as a sign of Crohn's disease in a pediatric patient: a case report. Pediatric dent 2004;26(4):355-8.
19. Girlich C, Bogenrieder T, Palitzsch KD, Schölmerich J, Lock G. Orofacial granulomatosis as initial manifestation of Crohn's disease: a report of two cases. Eur J Gastroenterol Hepatol 2002;14(8):873-6.
20. Mignogna MD, Fedele S, Lo Russo L, Lo Muzio L. Orofacial granulomatosis with gingival onset. J Clin Periodontol 2001;28(7):692-6.
21. Grave B, McCullough M, Wiesenfeld D. Orofacial granulomatosis–a 20‐year review. Oral Dis 2009;15(1):46-51.
22. Chaudhry SI, Philpot NS, Odell EW, Challacombe SJ, Shirlaw PJ. Pyostomatitis vegetans associated with asymptomatic ulcerative colitisA case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87(3):327-30.
23. Merkourea SS, Tosios KI, Merkoureas S, Sklavounou-Andrikopoulou A. Pyostomatitis vegetans leading to Crohn's disease diagnosis. Ann Gastroenterol 2013;26(2):187.
24. Brinkmeier T, Frosch PJ. Pyodermatitis-pyostomatitis vegetans: a clinical course of two decades with response to cyclosporine and low-dose prednisolone. Acta Derm Venereol 2001;81(2):134-6.
25. Anand P, Kunnumakkara AB, Newman RA, Aggarwal BB. Bioavailability of curcumin: problems and promises. Mol Pharm 2007;4(6):807-18.
26. Bogenrieder T, Rogler G, Vogt T, Landthaler M, Stolz W. Orofacial granulomatosis as the initial presentation of Crohn’s disease in an adolescent. Dermatology 2003;206(3):273-8.
27. Ciacci C, Bucci C, Zingone F, Iovino P, Amato M. Buccal localization of Crohn’s disease with long-term infliximab therapy: a case report. J Med Case Rep 2014;30;8:397.
28. Chandras S,Tripathi AK,Mishra S,Amzarul M,Vaish AK.physiological changes in hematological parameters during pregnancy. Indian J Hematol Blood Transfus 2012;28(3):144-6.
29. Maccioni F, Bruni A, Viscido A, Colaiacomo MC, Cocco A, Montesani C, et al. MR Imaging in Patients with Crohn Disease: Value of T2-versus T1-weighted Gadolinium-enhanced MR Sequences with Use of an Oral Superparamagnetic Contrast Agent. Radiology 2006;238(2):517-30.
30. Sanderson J, Nunes C, Escudier M, Barnard K, Shirlaw P, Odell E, et al. Oro‐facial granulomatosis: Crohn's disease or a new inflammatory bowel disease? Inflamm Bowel Dis 2005;11(9):840-6.
31. Leao JC, Hodgson T, Scully C, Porter S. Review article: orofacial granulomatosis. Aliment Pharmacol Ther 2004;20(10):1019-27.
32. Baert F, Moortgat L, Van Assche G, Caenepeel P, Vergauwe P, De Vos M, et al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn's disease. Gastroenterology 2010;138(2):463-8.
33. Terdiman JP, Gruss CB, Heidelbaugh JJ, Sultan S, Falck–Ytter YT. American Gastroenterological Association institute guideline on the use of thiopurines, methotrexate, and anti–TNF-α biologic drugs for the induction and maintenance of remission in inflammatory Crohn's disease. Gastroenterology 2013;145(6):1459-63.
34. Bokhari SA1, Khan AA, Butt AK, Azhar M, Hanif M, Izhar M et, al. Non‐surgical periodontal therapy reduces coronary heart disease risk markers: a randomized controlled trial. J Clin Periodontol 2012;39(11):1065-74.
35. Canavan C, Abrams KR, Mayberry J. Meta‐analysis: colorectal and small bowel cancer risk in patients with Crohn's disease. Aliment Pharmacol Ther 2006;23(8):1097-104.

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2021 CC BY-NC 4.0 | Journal of Research in Dental and Maxillofacial Sciences

Designed & Developed by : Yektaweb